Will your insurance type influence clinical quality outcomes? An investigation of contributing factors, underlying mechanism, and consequences

Although past studies have found differences in clinical quality outcomes based on patients' insurance type, the extent of these discrepancies, underlying mechanisms supporting this relationship, and factors that can moderate effect not yet been addressed. We seek to fill gap by studying relationship between type using level care received, is, treatment intensity, as a mediator. Using agency theory, we argue underinsured patients (patients insured Medicaid) will experience more adverse due lower intensity compared privately patients. then explore whether two contextual factors—patient complexity resource utilization—influence turn outcomes. use 2010–2016 data from California test relationships. The types used for comparison are private Medi-Cal (California's equivalent Medicaid, representing patients). A patient's 30-day readmission rate is measure log charges normalized wage index inflation (called intensity) proxy they received. within-hospital coarsened exact score matching create comparable group followed hospital fixed effects regression with errors clustered Results indicate mediates Further, difference reduced patient increases, while higher utilization at lowers its incentive provide equitable